Will psychotherapy become a thing of the past?

I (a UK trained Clinical Psychologist) often imagine this future scenario in 30 or so years’ time where a conversation comes up with one of my grandkids, the scene plays out in my mind something like this…

“So, Nanny, you’re telling me people used to go and pay to see someone, give up their own free time to sit down and go over and over all of their problems and all of the things that make them feel bad? I smile, “yes dear, that’s right.” Their response is one of utter confusion (a similar response I remember having when I was younger and realised that women used to have to obey men and cigarettes used to be considered healthy).

“Why on earth did people do that Nanny?” I try my best to explain.. “Well, we didn’t know any better at the time, that was the best we had available and what we thought we had to do to get better when we were struggling with our mental health, there wasn’t really any other option other than medication, but try to think where we had come from and how far we had come… before psychotherapy, mental health problems were once never thought treatable, and not that long ago, they didn’t even exist.”

“Geez Nanny, I’m glad I wasn’t born in those days and that it’s not as popular any more and we have more options that get us well.”

— — -

This blog is certainly not a dig at psychotherapy but rather a desire to highlight our evolution so far and the change in direction, for the better, that I see happening.

Firstly, as a previous psychotherapist I would like to highlight some important findings from decades of psychotherapy research that is not common knowledge in the general population, these findings have also generally been my experience during my 10 year career:

• Only about 50% of people who have psychotherapy for common mental health illnesses such as anxiety and depression will get better (i.e. respond to treatment).
• ‘Getting better’ isn’t the same thing as ‘getting well’ and a significant proportion of this 50%will still have residual symptoms after psychotherapy.
• Residual symptoms after treatment for anxiety and depression have been shown to be one of the biggest predictors of the mental illness returning (relapse).
• Only a very small percentage of people actually start to thrive after receiving psychotherapy.
• Some people actually get worse after psychotherapy and experience an increase in the severity of their symptoms.

These general findings haven’t changed pretty much since psychotherapy research began, so my point is, why is this not explained to the patient/client on referral, why is this not common knowledge? If I were considering taking a drug and a Doctor explained that there was a 50% chance that I would respond to the drug in a positive way, a considerable chance that nothing would change and a small chance that I could get worse, would I take the drug? probably not, I guess it would depend on how severe my symptoms were. If I had mild to moderate symptoms I might then ask “what do you mean by positive change” and if then the response was “well, the best you can expect really is a reduction in your symptoms, you’d still have an illness but it would be more manageable,” I would probably decide it wasn’t worth the effort or the risk.

My frustration is not at the limitation of psychotherapy but at the way it is being administered and branded as providing more than it is capable of. For example, only last week in the UK, the Work and Pensions Secretary, Mel Stride announced plans for people out of work due to milder mental health conditions to no longer receive financial support and to receive psychotherapy instead. With the knowledge above, I cant help but think these plans are going to waste too much money and do very little.

Unfortunately I do see a very dire future for psychotherapy…it quite frankly isn’t good enough, it doesn’t deliver the results that I predict the new generations are going to demand and it generally, I think, isn’t a very appealing option for most people, particularly men. I think the next generations are going to demand more and more, are going to want to see better outcomes and methods and services that are appealing and accessible quickly and flexibly. Psychotherapy, with all its research and different stages of evolution over the last 10/20 years, still cannot significantly break this 50% ceiling and I felt that in the therapy room myself, I was just not seeing my patients getting well, the best I could hope for was a reduction in their symptoms so they were easier to manage and unfortunately there were occasions where I saw people get worse. This is the best that can be achieved when the focus of an intervention is on the past and our problems. A different focus of attention is needed in order to significantly break this 50% ceiling…

So in 2021 I came up with an alternative, a new idea.. ‘personal training for mental fitness’ where the ‘therapist’ gets replaced with a ‘trainer’ and the focus is not on reducing the symptoms of an illness but rather on improving the performance and functioning of the brain. In 2023 I opened the UK’s first ‘Brain Gym. The brain PT methods I use are simple and effective and more clients appear to be consistently achieving better positive outcomes. As the method I use is simple, it will be reasonably straight forward to teach and train up other people to become what I have called a ‘Mental Fitness Personal Trainer.’ I called my brand of brain gym, “Spartannn” it is targeted at men who don’t want to talk about their problems and go to therapy but know they need to ‘sort their head out.’ I see in the next 30 years’ that there will be brain gyms everywhere (not just my brand) and then we will live in a time where it will be as easy to improve your mental fitness as it is to improve your physical fitness.